1. Queens Health Policy Change Conference Series Australian Health Reform Progress Prof Mick Reid May 2014 1

2. Health/Hospital Boards Most States have created District Hospital Boards -Devolved authority from State Authorities. -Increased local autonomy. -Improved clinical engagement. -Fostered local innovation e.g. Workforce. -Adopted transparent funding arrangements. -Greater public/private interaction to provide public services. 2

3. Primary Health Care Federal Government has created 61 ‘Medicare Locals’ throughout Australia – GP and other community health personnel. -In some States boundaries of Medicare Locals equate District Hospital Boards. -Joint Planning now enabled. -Some contracts evolved between DHBs and MLs re hospital avoidance/frequent flyers. -Still too early to judge overall effectiveness. -Under review. 3

4. Transparency/Performance National Health Performance Authority -Role to monitor and report on performance of public and private hospitals and Medicare Locals. -Reporting scope determined by Federal/State Health Ministers. -This year will publish first ‘poor performance’ report. -Complements actions of States in managing/monitoring performance of their hospitals. 4

5. Transparency/Pricing Independent Hospital Pricing Authority -Role is to calculate an annual National Efficient Price. -NEP determines Commonwealth funding contribution to hospitals according to hospital activity levels or block funding (for smaller hospitals). -In all States, public hospitals paid for number/mix of patients they treat. -Pricing extended from inpatient to outpatient clinics, community based clinics and inpatients homes (HITH). -Creates $ incentives for hospital avoidance, early discharge. -Greater pressure on hospitals as ‘efficient price’ more rigorously enforced. 5

6. E-Health National E-Health Transition Authority (NEHTA) owned by Federal/State governments. -Role is to develop foundations/services for national e-health capability. -Particular emphasis on creation of Personally Controlled Electronic Health Record. Designed for consumers to share health information with different providers. -Commenced 1/7/2012. An opt in system -1.5 million Australians have joined -strong collaboration with vendors re specs/standards -not a replacement for local clinical information systems. Currently under review (opt in to opt out/greater private ‘ownership’). 6

7. Safety and Quality Australian Commission of Safety and Quality in Health Care -Coordinates national improvements in safety and quality. -Focus on clinical communications/falls prevention/health associated infection/ medication safety/open disclosure/ accreditation standards/patient experience. 7

8. Health Reform Progress Uncertainties -Health Reform initiated prior to change to conservative governments Federally and in most States. -New governments concerned with achieving balanced budgets/decreasing government outlays. -Status of Commission of Audit Report -Federal Budget. 8

9. Commission of Audit Proposals -Universal access to bulk billing (i.e. free to consumer) GP services abolished. -$5–$15 copayment on GP attendances. -Increased copayment for pharmaceuticals. -Enforcing private health insurance for high income earners. -Introduce copayment for ‘GP like’ attendances at emergency departments. -Recommends merging of a number of national health agencies on pricing, performance, quality and data collection, abolishes others. -Allow pharmacists/nurses to take broader role. 9